Integrating oral PrEP delivery among African women in a large HIV endpoint‐driven clinical trial

作者：Ivana Beesham, Julia D Welch, Renee Heffron, Melanie Pleaner, Lara Kidoguchi, Thesla Palanee‐Phillips, Khatija Ahmed, Deborah Baron, Elizabeth A. Bukusi, Cheryl Louw, Timothy D. Mastro, Jennifer Smit, Joanne Batting, Mookho Malahleha, Veronique Bailey, Mags Beksinska, Deborah Donnell, Jared M. Baeten · 发表于：Journal of the International AIDS Society · 年份：2020 · DOI：10.1002/jia2.25491 · 被引用次数：26 · 研究领域：HIV/AIDS Research and Interventions、Reproductive tract infections research、HIV, Drug Use, Sexual Risk

INTRODUCTION: Global guidelines emphasize the ethical obligation of investigators to help participants in HIV-endpoint trials reduce HIV risk by offering an optimal HIV prevention package. Oral pre-exposure prophylaxis (PrEP) has increasingly become part of state-of-the-art HIV prevention. Here we describe the process of integrating oral PrEP delivery into the HIV prevention package of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial. METHODS: ECHO was an open-label randomized clinical trial that compared HIV incidence among women randomized to one of three effective contraceptives. In total, 7830 women aged 16 to 35 years from 12 sites in four African countries (Eswatini, Kenya, South Africa and Zambia) were enrolled and followed for 12 to 18 months, from 2015 to 2018. Part-way through the course of the trial, oral PrEP was provided to study participants either off-site via referral or on site via trained trial staff. PrEP uptake was compared between different contraceptive users using Chi-squared tests or t-tests. HIV seroincidence rates were compared between participants who never versus ever initiated PrEP using exact Poisson regression. RESULTS: PrEP access in ECHO began through public availability in Kenya in May 2017 and was available at all sites by June 2018. When PrEP became available, 3626 (46.3%) eligible women were still in follow-up in the study, and of these, 622 (17.2%) initiated PrEP. Women initiating PrEP were slightly older; more likely ...